OBJECTIVES: Our objective was to assess the use of several tests of ProSeal LMA (PLMA) position and function that had been previously published but not studied in the pediatric population in a wide variety of clinical cases. BACKGROUND: The PLMA is widely used in pediatric anesthesia practice but complication rates ...

An 11-year-old male developed a severe respiratory failure due to a iatrogenic flail chest following a surgery for removing a large chest wall area. A rare Ewing sarcoma was histologically diagnosed and intensive chemotherapy was administered. Postoperatively, because of the failure in ventilation weaning, the patient was electively extubated and ...

PURPOSE OF REVIEW: Hypovolemia is one of the most frequent causes of arterial hypotension in the operating room. Pulse oximeter plethysmographic waveform, obtained using a noninvasive and widely available device, has recently shown its potential interest in predicting fluid responsiveness in mechanically ventilated patients under mechanical ventilation. This review highlights ...

BACKGROUND: Studies have found that increasing the respiratory frequency during mechanical ventilation does not always improve alveolar minute ventilation and may cause air-trapping. OBJECTIVE: To investigate the theoretical and practical basis of higher-than-normal ventilation frequencies. METHODS: We used an interactive mathematical model of ventilator output during pressure-control ventilation to predict ...

BACKGROUND: There are insufficient data as to the influence of the head and neck flexion, extension, and rotation on the ventilation with laryngeal tube suction II (LTS II). The purpose of this study was to investigate the influence of the head and neck position on oropharyngeal sealing pressure (primary outcome) ...

Air leaks often result in alveolar hypoventilation in mechanically ventilated patients with neuromuscular disease. The primary objective of this study was to assess the feasibility, efficacy and tolerance of a ventilator equipped with an automated air-leak compensation system in a clinical situation. Fourteen neuromuscular patients with nocturnal air leaks during ...

Mechanical ventilation using high tidal volume (VT) and transpulmonary pressure can damage the lung, causing ventilator-induced lung injury. Permissive hypercapnia, a ventilatory strategy for acute respiratory failure in which the lungs are ventilated with a low inspiratory volume and pressure, has been accepted progressively in critical care for adult, pediatric, ...

Rationale: Numerous factors affect aerosolized drug delivery during invasive ventilation. However, there is few data concerning measurement of tidal volume and pressures on the ventilator and similarly on the lung during a nebulization. Aim: To evaluate the effect of aerosol devices in two modes of mechanical ventilation on the measurement ...

To optimize the successful use of noninvasive positive-pressure ventilation (NPPV) in the emergency department (ED), clinicians must acquire the necessary knowledge, experience, and skill in its proper application. The purpose of this article is to provide a concise but thorough review of the current state of knowledge relating to the ...

BACKGROUND: Small endotracheal tubes (ETTs) and neonatal ventilators can impact gas exchange, work of breathing, and lung-mechanics measurements in infants, by increasing the expiratory resistance (R(E)) to gas flow. METHODS: We tested two each of the Babylog 8000plus, Avea, Carestation, and Servo-i ventilators. In the first phase of the study ...

This study tested the "Target Method" for adjusting ventilation systems. The Target Method is based on target hood static pressures (SPh(target)) computed in a manner designed to take into account the estimated effects of dampers on the fan, the order of damper adjustments, and the ratio of the prebalancing branch ...

BACKGROUND: Traditionally, specific ventilators have been manufactured to only provide neonatal mechanical ventilation. However, many of the current generation of ICU ventilators also include a neonatal mode. METHODS: Using the IngMar ASL5000 lung simulator the Puritan Bennett 840, the Maquet Servo i, the Viasys AVEA, the GE Engström, the Drager ...

Numerous pressure modes are currently available on ventilators. The application of microprocessor technology has resulted in sophisticated mode options that are very responsive to patient-initiated efforts, yet little is known about how to use the modes or their effect on patient outcomes. This article describes a wide variety of pressure ...

PURPOSE OF REVIEW: Patients with acute pulmonary edema are often treated with noninvasive ventilation (NIV). There are essentially two modalities used in this setting: continuous positive airway pressure and bilevel pressure support ventilation. The clinical impact of these techniques and the subset of patients who can benefit from their application ...

Positive pressure ventilation is a radical departure from the physiology of breathing spontaneously. The immediate physiological consequences of positive pressure ventilation such as haemodynamic changes are recognized, studied, and understood. There are other significant physiological interactions which are less obvious, more insidious, and may only produce complications if ventilation is ...

BACKGROUND: Retention of airway secretions is a common and serious problem in ventilated patients. Treating or avoiding secretion retention with mucus thinning, patient-positioning, airway suctioning, or chest or airway vibration or percussion may provide short-term benefit. METHODS: In a series of laboratory experiments with a test-lung system we examined the ...

OBJECTIVE: The use of pulse pressure variation (PPV) and systolic pressure variation (SPV) is possible during controlled ventilation (MV). Even in acute respiratory failure, controlled MV tends to be replaced by assisted ventilatory support. We tested if PPV and SPV during flow triggered synchronized intermittent mechanical ventilation (SIMV) could be ...

BACKGROUND: Flexible bronchoscopy performed through endotracheal tubes (ETTs) in children receiving mechanical ventilation can significantly impact ventilation, but the magnitude of this impact has not been established. We used a lung model to simulate mechanical ventilation in a range of child sizes in order to determine how the insertion of ...

We determined the need for changes in minute ventilation with adaptive support ventilation after percutaneous dilatational tracheotomy under endoscopic guidance in 34 intensive care unit patients. During the procedure, minute ventilation was not changed; only maximum pressure limits were adjusted, if necessary. After insertion of the tracheotomy, cannula minute ventilation ...

OBJECTIVE: To report the use of high frequency oscillatory ventilation (HFOV) in two children with severe traumatic brain injury and concurrent lung pathology where conventional mechanical ventilation was ineffective. DESIGN:: Case report. SETTING: Regional intensive care unit in a pediatric teaching hospital. PATIENTS: Two severely head-injured children (both with postresuscitation ...

Acute lung injury (ALI), as occurs with prolonged mechanical ventilation, contributes to morbidity and mortality of critical illness, and studies on novel genetic or pharmacological targets are areas of intense investigation. Here, we systematically tested a murine model of ALI by using pressure-controlled ventilation to induce ventilator-induced lung injury. For ...

BACKGROUND: Mechanical ventilation with small tidal volumes reduces the development of ventilator-induced lung injury and mortality, but may increase PaCO2. It is not clear whether the beneficial effect of a lung-protective strategy results from reduced ventilation pressures/tidal volumes or is mediated by the effects of hypercapnic acidosis on the inflammatory ...

Noninvasive positive pressure ventilation (NPPV) is becoming more commonplace, both in the ICU and also in the Emergency Department. This article addresses the rationale and mechanism of action for NPPV. A review of the indications for using NPPV and a discussion detailing the initiation of NPPV follows. NPPV has been ...

OBJECTIVE: The objective of this study was to identify the definitional criteria for the pressure-limited and time-cycled modes: airway pressure release ventilation (APRV) and biphasic positive airway pressure (BIPAP) available in the published literature. DESIGN: Systematic review. METHODS: Medline, PubMed, Cochrane, and CINAHL databases (1982-2006) were searched using the following ...

OBJECTIVE: Neurally adjusted ventilatory assist (NAVA) is a new mode wherein the assistance is provided in proportion to diaphragm electrical activity (EAdi). We assessed the physiologic response to varying levels of NAVA and pressure support ventilation (PSV). SETTING: ICU of a University Hospital. PATIENTS: Fourteen intubated and mechanically ventilated patients. ...

Subcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review ...

BACKGROUND: Pressure-support ventilation (PSV) is more comfortable than volume controlled-continuous mandatory ventilation (VC-CMV) in acute hypercapnic respiratory failure, in patients undergoing noninvasive ventilation. Physiologic measurements of patient status have been compared in PSV and VC-CMV in endotracheally intubated patients, but patient perception of comfort has not been measured in this ...

Ventilated patients frequently require transport by air in a hypobaric environment. Previous studies have demonstrated significant changes in the performance of ventilators with changes in cabin pressure (altitude) but no studies have been published on the function of modem ventilators at altitude. This experiment set out to evaluate ventilatory parameters ...

Term and near-term infants with pulmonary hypertension are frequently treated with inhaled nitric oxide. This therapy can be delivered with high-frequency ventilation, but there has been limited study of the relative effectiveness of high-frequency jet ventilation and high-frequency oscillatory ventilation. OBJECTIVE: To compare short-term clinical outcomes of neonates with pulmonary ...

BACKGROUND: We compared spontaneous and positive-pressure ventilation in patients undergoing general anaesthesia for the treatment of extrathoracic, intralumenal laryngotracheal stenosis to assess the best method of ventilation in this patient group. METHODS: Records of 30 patients with laryngotracheal stenosis, but not with a tracheostomy, undergoing lumen-restoring surgery were prospectively reviewed. ...

AIM: The importance of ventilatory support during cardiac arrest and basic life support is controversial. This experimental study used dynamic computed tomography (CT) to assess the effects of chest compressions only during cardiopulmonary resuscitation (CCO-CPR) on alveolar recruitment and haemodynamic parameters in porcine model of ventricular fibrillation. MATERIALS AND METHODS: ...

During sleep changes in central and peripheral neurological pathways and muscle tone result in unique vulnerabilities in the respiratory system. Abnormalities of the respiratory system that are not apparent in wakefulness can become evident during particular sleep states, making overnight polysomnography (PSG) a valuable diagnostic indicator of the source as ...

Lung protective ventilatory strategies using conventional ventilators have resulted in decreased mortality in adult patients who have acute lung injury and acute respiratory distress syndrome. Conceptually, high frequency oscillatory ventilation and airway pressure release ventilation appear not only able to fulfill the goals of lung protection, but also to offer ...

The standard of care for mechanical ventilation of the patient who has acute lung injury remains volume control ventilation at 6 mL/kg. Despite this fact, clinicians often employ pressure control ventilation and adaptive pressure control ventilation in an attempt to improve synchrony and limit the possibility for overdistension. Adaptive pressure ...

OBJECTIVE: Dynamic ventilation (3)He-MRI is a new method to assess pulmonary gas inflow. As differing airway diameters throughout the ventilatory cycle can influence gas inflow this study intends to investigate the influence of volume and timing of a He gas bolus with respect to the beginning of the tidal volume ...

Pressurized metered-dose inhalers (pMDIs) and nebulizers are employed routinely for aerosol delivery to ventilator-supported patients, but the ventilator circuit and artificial airway previously were thought to be major barriers to effective delivery of aerosols to patients receiving mechanical ventilation. In the past two decades, several investigators have shown that careful ...

BACKGROUND: The authors hypothesized that nasal mask ventilation may be more effective than combined oral-nasal mask ventilation during induction of general anesthesia. They tested this hypothesis by comparing the volume of carbon dioxide removed per breath with nasal versus combined oral-nasal mask ventilation in nonparalyzed, apneic, adult subjects during induction ...

Patient-ventilator synchrony during non-invasive pressure support ventilation with the helmet device is often compromised when conventional pneumatic triggering and cycling-off were used. A possible solution to this shortcoming is to replace the pneumatic triggering with neural triggering and cycling-off-using the diaphragm electrical activity (EA(di)). This signal is insensitive to leaks ...

The cyclic appearance of dynamic left ventricular outflow tract obstruction during mechanical ventilation, according to the phasic changes in preload, is described in this article. Hemodialysis-induced fluid removal resulted in preload dependence as evidenced by the pulse pressure variation in a 56-year-old critically ill patient. The clinical picture was suggestive ...